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BDS4 Paediatric Dentistry > Dentistry for Children in Primary Care > Flashcards

Dentistry for Children in Primary Care Flashcards

1
Q

Where is the majority of paediatric dentistry carried out and what are the subsections of this?

A
  • general dental service
    • independent dentists
      • full range of NHS dental care
    • PDS
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2
Q

What details the primary NHS fee structure in Scotland?

A
  • Statement of Dental Remuneration
    • SDR
    • determination 1
    • details 45 treatments on NHS
      • previously 700
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3
Q

What does the enhanced preventive advice and treatment plan cover and how often can this be claimed?

A
  • OHI
  • TBI and interdental cleaning demo
  • food and drink advice
  • application of fluoride varnish
  • PMPR
  • fissure sealants
  • SDF
  • can be claimed every 3 months
    • £19.60
  • fissure sealants £12.70 per tooth
    • unfilled molars or hypoplastic premolars
      • must be within 2 years of eruption
    • fee covers maintenance
    • high risk patients covered for multiple
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4
Q

What does the primary care NHS fee structure cover?

A
  • provision of orthodontic appliances
  • management of dental trauma
    • e.g. splint
  • sedation
    • assessment fee (£37.10)
    • sedation (£111.30 per visit)
  • supportive preventive care
  • supports minimally invasive dentistry
  • weighted payments
    • SIMD 1 zones
    • special care
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5
Q

What are the roles of the GDP for paediatric dentistry?

A
  • management of dental caries
  • emergency dental care
  • monitoring the developing dentition
  • MIH
  • orthodontic care
  • child protection
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6
Q

What is the role of the GDP for management of dental caries in paediatric patients?

A
  • prevention alone
  • cannot just monitor
  • biological management
  • minimally invasive
  • conventional restorative options
  • extractions
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7
Q

What is the role of the GDP for emergency dental care in paediatric patients?

A
  • emergency care
    • outwit normal working hours
  • acute dental problems
    • pain
    • pulpitis
    • abscess
    • swelling
  • management of dental trauma
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8
Q

What is the role of the GDP for monitoring the developing dentition in paediatric patients?

A
  • important milestones
    • 3 years old
      • all primary teeth erupted
    • 6 years old
      • eruption of FPM
      • acclimatisation for fissure sealants
      • increased mobility of lower centrals
    • 9 years old
      • palpate crown of upper canines
      • buccal sulcus
    • 12 years old
      • all primary teeth exfoliated OR
      • close to exfoliation
  • sequence of eruption
    • significant delay
      • hypodontia
      • ectopic canines
      • supernumeraries
    • matching lower and upper teeth
      • up to 12 months
    • matching teeth on either side
      • up to 6 months
  • developing malocclusions
    • IOTN
      • severity of malocclusion
    • timely assessment for referral
      • increased treatment options
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9
Q

What is the role of the GDP in management of molar-incisor hypomineralisation?

A
  • identification
    • 2.8%-40.2%
  • symptoms requiring management
    • hypersensitivity
    • crumbling back teeth
    • aesthetic concerns surrounding incisors
  • management options
    • seal
    • restore with plastic restoration
      • e.g. Fuji triage over affected areas
    • PMC
    • extractions
      • 9/10 years old
      • advice from ortho or paeds
    • aesthetic management
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10
Q

What is the role of the GDP in orthodontic care in paediatric patients?

A
  • simple orthodontic treatment
    • removable appliances
    • fixed appliances
    • aligners
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11
Q

What is the role of the GDP in child protection in paediatric patients?

A
  • likely to come across a child protection concern throughout career
  • useful resources
    • Department of Health
      • child protection and the dental team
    • BSPD
      - policy document on dental neglect
    • RCPCG
      • safeguarding children and young people
    • Scottish Government
      • national guidance for child protection
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12
Q

What personal factors contribute to caries development?

A
  • poverty
  • toothbrushing habits
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13
Q

What oral environmental factors contribute to caries development?

A
  • saliva
  • plaque traps
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14
Q

What factors directly contribute to caries development?

A
  • time
  • tooth
  • bacteria
  • dietary carbohydrate
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15
Q

What three sections make up prevention of caries?

A
  • caries risk assessment
  • behaviour modification
  • tooth protection
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16
Q

What is primary prevention?

A

preventing the occurrence of disease

17
Q

What is secondary prevention?

A

preventing progression of a lesion

18
Q

What are the 7 components of a caries risk assessment and which is the biggest indicator of caries risk?

A
  1. clinical evidence of previous disease
  2. dietary habits
  3. oral hygiene habits
  4. exposure to fluoride
  5. social history/socioeconomic status
  6. saliva
  7. medical history

socioeconomic status is the most relevant caries risk indicator

19
Q

What factors can affect saliva when considering caries risk assessment?

A
  • diabetes
  • xerostomia
  • beta 2 angonists/corticosteroid inhalers
  • anticonvulsants
  • antihistamines
  • desmopressin
  • acne treatment
20
Q

What behaviour modification can be carried out to manage caries development?

A
  • attendance patterns
  • toothbrushing habits
  • use of home fluoride
  • drinking and dietary habits
  • acclimatisation
21
Q

What is motivational interviewing?

A

collaborative, goal-oriented style of communication with particular attention to the lingual of change, designed to strengthen personal motivation

22
Q

What methods of tooth protection exist for paediatric patients in primary care?

A
  • fluoride varnish
    • 22,600ppm sodium fluoride
      - 50mg/ml, 5%
    • every 3 months for high risk
  • fissure sealants
    • susceptible molars
  • fluoride toothpaste
    • can be prescribed from 10 years old
    • 2,800ppm sodium fluoride
      • 0.619%
  • silver diamine fluoride
23
Q

What is SDF and how does it work?

A
  • silver diamine fluoride
    • colourless 38% solution (RivaStar)
    • 44,800ppmF
  • synergistic effects
    • occludes dentinal tubules
    • antibacterial
      • kills cariogenic bacteria
    • fluoride encourages remineralisation
24
Q

What are the advantages of SDF?

A
  • safe
  • simple and quick (5 minutes)
  • non-AGP
  • non invasive
  • evidence based
25
Q

What are the disadvantages of SDF?

A
  • stains caries black
  • temporary tattoo of soft tissues
  • relatively expensive (£110 for 1.5ml)
  • not in SDR with a service fee
  • metallic taste (mask with mint toothpaste)
26
Q

Why is caries diagnosis more challenging in paediatric patients?

A
  • not ideal clinical conditions
    • unpredictable
  • anatomical challenges
    • small mouths
    • larger tongues
    • shorter necks
27
Q

Why might primary molars be more prone to caries development and what are the problems caused by this?

A
  • wider contact points
    • hard to spot until caveatted
  • larger pulps
  • faster spread of caries into the pulp
28
Q

How should caries diagnosis be carried out for paediatric patients in primary care?

A
  • up to 50% of caries in primary molars can be missed without a radiographic exam
  • consider bitewings from age 4
    • usually can tolerate
    • contacts start to close at this age
  • taken at intervals dependent on risk
    • 6 months for high risk
    • 24 months for low risk
  • use paediatric sized films/plates/sensors
    • larger can dig in or cause gagging
  • consider separators if bitewings not managed
    • caries diagnosis possible
    • also plan for PMC
29
Q

What options are available for management of caries in paediatric patients in primary care?

A
  • non-invasive
    • biofilm control
    • mineralisation control
    • dietary control
    • requires no barriers to caregivers
  • micro-invasive
    • sealing
    • resin infiltration
      • ICON
  • minimally invasive
    • atraumatic restorative technique (ART)
      • effective for single surface lesions
      • must be done correctly
  • conventional restorative
    • increased risk of pain and anxiety
  • mixed
    • non restorative cavity control
      • self cleansing cavity
      • must be close to exfoliation
      • must be symptom controlled
      • must be infection free
    • hall technique
      • best survival for occlusal proximal
      • quick and easy to place
      • must be symptom controlled
      • must be infection free
30
Q

What is the guidance surrounding use of amalgam in paediatric patients in primary care?

A
  • SDCEP guidelines
  • no longer allowed in children under 15
    • only used in exceptional circumstances
  • not allowed in pregnant or breast feeding
31
Q

What type of restoration has the greatest longevity in posterior restoration of primary teeth?

A

preformed metal crowns

32
Q

What variables must be considered for caries intervention?

A
  • caries risk
  • age of child and ability to cope
  • length of time until exfoliation
    • consider survival rates
    • reduce the need for treatment
  • choice of material
    • ease of use
    • survival rate
  • minimally invasive considered first
  • payment system
33
Q

Where might a paediatric patient be referred to from primary care?

A
  • PDS
  • HDS
  • orthodontic services
  • non-dental services
34
Q

Why might a referral be made for a paediatric patient to attend PDS?

A
  • anxiety and phobia
  • GA extractions
  • sedation
  • special needs
  • vulnerable groups
35
Q

Why might a referral be made for a paediatric patient to attend HDS?

A
  • management of severe caries
  • medical conditions
  • trauma
  • dental defects
  • multidisciplinary care
36
Q

Why might a referral be made for a paediatric patient to attend orthodontic services?

A
  • developing malocclusion
  • dental anomalies
37
Q

What non-dental services might a paediatric patient be referred to?

A
  • child protection
  • social services
38
Q

What are the indications for a paediatric patient to receive a general anaesthetic?

A
  • the child needs to be fully anaesthetised before dental procedures can be attempted
  • the surgeon needs the child fully anaesthetised before dental treatment can be performed
  • only appropriate when there is no other reasonable, acceptable way to restore health and there is significant and prolonged risk of problems arising without treatment
39
Q

What are the 3 golden rules for treating paediatric patients in primary care?

A
  1. effectively manage disease in a way the child can cope
  2. ensure the treatment plan is achievable for the parent
  3. promote a positive dental attitude

BDS4 Paediatric Dentistry (11 decks)

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